Provider Demographics
NPI:1881055549
Name:AKIMOVA, IRINA (LCSW, LSOTP, CADC)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:AKIMOVA
Suffix:
Gender:
Credentials:LCSW, LSOTP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W. JUDD STREET
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60073
Mailing Address - Country:US
Mailing Address - Phone:773-729-9469
Mailing Address - Fax:
Practice Address - Street 1:715 W. JUDD STREET
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60073
Practice Address - Country:US
Practice Address - Phone:773-729-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
IL1490206891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker